[ comparison between the results of fissurectomy and lateral internal sphincterotomy in the management of chronic anal fissure]

Although lateral internal sphincterotomy is an effective treatment of chronic fissure in ano, it may lead to serious complications, of these, incontinence to flatus and fecal soiling are the most distressing. To avoid such complications, we proposed fissurectomy as an alternative surgical treatment. Totally, 62 consecutive patients through the sequential sampling were divided into two groups. 30 patients underwent fissurectomy [F] and 32 underwent lateral internal sphincterotomy [LIS]. After a median follow-up of 22 months, we compared the results of the two procedures. In addition to frequent visits on a predetermined basis, a telephone inquiry into fissure recurrence and continence status was made. All patients in either group were pain free and without bleeding within one week. In both groups urinary retention was noted in one patient. Incontinence to flatus was in the LIS group in two [6.2%] patients but no incontinence was noted in the F group. There was one patient [3.1%] with fissure recurrence in the LIS group but no one in the F group. No patient in either group afflicted with anal stenosis or perianal infections. All wounds healed within 8 weeks. 29 patients [96.6%] in the F group and 28[87.5%] in the LIS group reported satisfactory results with their procedure. In the surgical treatment of chronic anal fissure not responding to conservative management, fissurectomy may be a sphincter-sparing alternative and perhaps preferable surgical technique with less total complications

[Comparative study of the plasma Homocysteine level in patients with mild Parkinson's disease and moderate to severe Parkinson's disease]

Patients with Parkinson's disease [PD] have higher concentration of plasma homocysteine [Hcy]. Elevation of total serum Hcy level has been known as a risk factor for neurodegenerative diseases. The aim of this study was comparison of serum Hcy level between PD patients with stage =< 2.5 and PD patients with stage > 2.5 [according to modified Yohen and Yahr method], and assessing the association between the duration of disease and Hcy levels. This case - control study was done on 50 patients with Parkinson's disease in the year 2005 in Al - Zahra Hospital of Isfahan. Patients divided into two groups: control group 1 included 23 patients with mild disease [stage=<2.5]; 27 patients with sever Parkinson's [stage>2.5] were put in the case group 1. Considering the duration of the disease, also, patients were divided into case 2 [more than 4 year duration with 24 patients] and control 2 [less than 4 year duration with 26 patients] groups. Hcy level was measured in all patients and compared in different groups. Individual and laboratory data were collected in questionnaire and analyzed using descriptive statistics and frequency distribution tables. The mean serum Hcy level in severe PD group was 24.96 micro mol/lit and in mild PD group was 25.07 micro mol/lit. There was no significant statistical difference between them. The mean serum level of Hcy, without any significant difference, in patients with duration of disease lower than 4 years was 23.51 micro mol/lit and in group with duration of more than that was 26.40 micro mol/lit. The present study showed that serum Hcy level doesn't have any relation with stage and duration of disease, and cannot be used as a predictive value for the progression of PD